Your healthcare coverage is important to us. Age, family status, medical conditions, hobbies, lifestyle and a myriad of other factors will help you determine if you need a lot or a very little amount of health coverage. This summary will help you understand your plan and its coverage.
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Summary Of Medical Benefits
Copay Plan
In-Network
Out-Of-Network
Calendar Year Deductible
Employee Only
Family
$2,000
$4,000
Coinsurance
30%
50%
Out-Of-Pocket Maximum
$4,500
$9,000
$18,000
Preventive Care
100% Covered
50%*
Primary Office Visit
Specialist Office Visit
Chiropractic Visit
Urgent Care Services
$25 Copay
$50 Copay
Complex Imaging: MRI/CT/PET Scans
30%*
Inpatient Hospital Care
Facility Fee
Physician Fee
Outpatient Procedures
No Charge
Emergency Services**
Emergency Room
Emergency Medical Transportation
$250 Copay
Mental health/Chemical Dependency
Inpatient
Outpatient
Prescription Drug Coverage
Generic
Preferred brand
Non-preferred brand
Specialty
Retail 30 Day Supply
$20 Copay
$40 Copay
$60 Copay
Mail Order 90 day Supply
$80 Copay
$120 Copay
Not Available
*After Deductible
**Covered as in-network in true emergency
If you prefer talking with a HealthEZ representative, call 1-877-516-6685